Provider Demographics
NPI:1275535866
Name:LANDKAMMER, BRENT JOSEPH (PMHNP-BC, ARNP)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:JOSEPH
Last Name:LANDKAMMER
Suffix:
Gender:M
Credentials:PMHNP-BC, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 N CENTER PKWY STE N197
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7160
Mailing Address - Country:US
Mailing Address - Phone:509-957-2130
Mailing Address - Fax:509-957-2096
Practice Address - Street 1:1030 N CENTER PKWY STE N197
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7160
Practice Address - Country:US
Practice Address - Phone:509-957-2130
Practice Address - Fax:509-957-2096
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60966969363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00007970OtherWA COUNSELOR LICENSE